HomeMy WebLinkAboutMengeweit 40c,c)- ' C
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Town Hall, 53095 Main Road
, t P.O. Box 1179
,.i!' Southold, New York 11971
JUDITH T.TERRY zi= FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1196-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MENGEWEIT, WALTER AND JUDITH
Mailing Address 1 P. O. BOX 186
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 430 TUCKERS LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2566
Tax Map No. section 63.00 block 5 lot 4.000
Cross Street ROUTE 25
Date Of Last Pump Out 0/00/00
Issue Date: 7/31/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
,
•
OFFICE OF THE TOWN CLERK S\\FFli�
Town of Southold , �� CQ ' Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ' ", . $10.00 - Residential ✓
P. O. Box 1179 ` `tt `' $25.00 - Non-Residential
Southold, New York 11971 O` O% �,
Telephone _vl * 10";
�•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee
DATE
OWNER NAME: alien. �• ✓U i 71 T4tTtWeI t'
OWNER MAILING ADDRESS:PO . 430A' Pg6
S 'h D(d ) A (/97/
OWNER PROPERTY ADDRESS: ) 736 5 k
Sp heCat Afl ) 114'?j
° OWNER TELEPHONE NUMBER: 5/4 ..766 a5Grp
i
TAX MAP NO. : Section 6.3 Block Lot
CROSS STREET: 411 45
TYPE OF SYSTEM: Septic Tank V New Existing �/
Cesspool New Existing
Residential ✓, Non-Residential
DATE OF PREVIOUS PUMP-OUT: igff' d)
LOCATION MAP: Must be attached hereto before permi_t_may be. issued. _
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
/► 1r / , r
Signature . i Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
. . .
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